Purpose: The spine is the most common skeletal site for metastatic tumors. In the treatment of vertebral metastases, the absolutely safe number of levels that can be treated via percutaneous kyphoplasty (PKP) during one procedure remains controversial. Thus, the present study aimed to evaluate the safety and efficacy of multilevel (>3) PKP for painful osteolytic vertebral metastases.Patients and methods: We retrospectively analyzed the data from 176 patients who received PKP for painful osteolytic spinal metastases. Group A (n=104) received PKP at a maximum of three vertebral levels per procedure, while group B (n=72) received PKP at more than three levels during one operation. Surgical efficacy was assessed via a comparison of the VAS, Oswestry Disability Index (ODI), and general health (GH) and mental health (MH) scores of the Short Form-36 Health Survey before and after PKP. The complications were observed to evaluate the safety.Results: Both groups had significantly improved VAS, ODI, GH and MH scores after PKP (P<0.05). One week after surgery, group A had significantly less pain (VAS 3.41±0.1) than group B (VAS 3.74±0.13) (P<0.05). At 3 and 6 months postoperatively, the GH score was more significantly improved in group A than group B (P<0.05). There were no significant differences between the two groups in the ODI, MH score, and complications (P>0.05).Conclusion: Multilevel PKP is safe and results in effective pain relief, and improvement of spinal mobility and GH in patients with osteolytic vertebral metastases. However, patients who undergo PKP at more than three levels have slightly worse short-term pain relief (less than 1 week postoperatively) and improvement of GH in the long-term (more than 3 months postoperatively) compared with patients who undergo PKP at less than three levels.

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